Data show some vendors better than others at Stage 2 MU

EHR vendors are achieving drastically different levels of success getting their clients to attest to Stage 2 of meaningful use, according to an analysis of CMS data. It suggests that last year’s relaxation of the program was particularly helpful to the clients of particular EHR companies.

The analysis by the data journalism group DocGraph.org showed that among the 20 EHR vendors whose clients received the most meaningful use payments in 2014, only Epic, athenahealth and Florida-based Modernizing Medicine managed to get more than 99 percent of their clients attested to Stage 2 without taking advantage of CMS' flexibility rule.

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For most of the leading EHR vendors, between 5 percent and 15 percent of their clients use the flexibility rule — which was finalized late in the year and enabled those scheduled to attest to Stage 2 to attest instead to Stage 1, using 2011- or 2014-certified EHR technology.

The clients of three major vendors — NextGen, GE Healthcare and Greenway — took advantage of the flexibility rule at particularly high rates, according to this analysis. Two-thirds of the meaningful use payments received by GE Healthcare’s clients in 2014 were for attestations done under the flex rule. Some 31 percent of NextGen clients and 47 percent of Greenway clients used the rule.

In general, cloud-based companies had greater success than enterprise systems in achieving Stage 2 attestation without resorting to the 2014 flex rule. Cloud-based NexTech, Practice Fusion, Evident and eClinicalWorks got 94 percent or more of their clients to attest without resorting to the rule.

Interpretations of the data vary. Only about 10 percent of physicians and 40 percent of hospitals overall attested to Stage 2 last year. Spokesmen for Epic and athenahealth, unsurprisingly, said the figures reflected the success of their products.

The data "does more than any marketing piece we could produce to underscore the value and power of the cloud-serviced model,” said Dan Haley, general counsel of athenahealth. “Our clients did not need to claim the flexibility rule. They had the software and workflows to enable success in Stage 2.

“ONC is paying an awful lot of taxpayer money for systems that are either incapable of meeting meaningful use requirements or for whatever reason are not being used effectively,” he added.

Fred Trotter, a health IT expert with DocGraph — a company whose funders include athenahealth — said that by issuing the flex rule, CMS had essentially stopped rewarding companies that had a competitive edge, while rewarding the laggards.

“If this were an industry-wide problem, you’d see that everyone had trouble meeting Stage 2. Or maybe that vendors who were all cloud-based had an advantage,” said Trotter. “But instead we see this huge variation.”

“GE has been paid by these clients, and indirectly by the taxpayers, but they have failed to produce what they were certified to produce,” he added.

Some health care officials argue that vendors had to take advantage of flexibility because development time frames were too fast-paced. Over all, only about 10 percent of providers and 40 percent of hospitals attested to Stage 2 last year.

“Until the focus shifts from one where the development of systems is based upon measurement versus one that helps drive better patient outcomes, we are going to see challenges with how well the systems perform,” said Mari Savickis, CHIME’s vice president of federal affairs. Vendors need to be able to "focus more on innovation rather than prescriptively dictating how a provider must use a system.”

Spokespersons for GE and NextGen acknowledged the high rate of Stage 2 deferments. Greenway said two mergers it conducted in 2014 may have slowed its software development as well as implementations.

“I don’t have any real quibbles with what the numbers are saying,” said Greg Fulton, director of industry and government affairs at Greenway. “The language in the flex rule was pretty open-ended. If they didn’t attest, they could just say, ‘I couldn’t.’”

NextGen says about 1,000 of its users attested to Stage 2 successfully in 2014. “So having the majority of our clients elect flexibility doesn’t mean that our products didn’t support the Stage 2 requirements,” said Sarah Corley, the company’s chief medical officer.

“It instead paints a picture of a client base of pretty smart business people going for the money with what they knew was not a stretch,” she said. “If you have already been successful at Stage 1, which was much easier, why would you bother trying to do something that had harder-to-meet thresholds and required more interfaces, a patient portal, etc.?”

Besides, she said, the timelines of the final rule release did not allow the majority of NextGen’s clients the time needed to adopt new workflows, so the company continued supporting their Stage 1 attestations.

Mark Segal, vice president for government and industry affairs at GE, said his company rolled out a product upgrade on time, but “given the complexity of doing full implementations as defined by CMS, many customers felt they needed to take advantage of the flex rule and we supported them in this option."

Trotter of DocGraph noted that providers who took the flexibility rule were supposed to be able to show their vendors could not support Stage 2 attestation. "It is reasonable for a vendor to blame ONC, which was late in releasing the information they needed to implement the Stage 2 rule, but it is not reasonable for them to blame their clients," he said.

GE Healthcare, NextGen and Greenway said they were having success enabling their customers to succeed with Stage 2 for 2015, although many providers are relying on a second, 2015 flex rule that CMS is expected to issue soon.